AFFIDAVIT with WAIVER

AFFIDAVIT with WAIVER (Current member) REPUBLIC OF THE PHILIPPINES) IN THE CITY OF BAGUIO) S.S.

I, ______, of legal age, Filipino citizen and a resident of ______, after having been duly sworn in accordance with law hereby depose and state that:

1. I am registered as a member-consumer of the Benguet Electric Cooperative, Inc. (BENECO) with the following account/s, to wit: ______

2. I hereby waive my rights and obligations for the said BENECO Account/s in favor of ______, who is my ______.

3. I am waiving my rights over my BENECO Account/s and support the application for the Change of Account in favor of the above named on the following reasons, to wit: ______.

4. I hereby declare that BENECO, its President, members of the Board, officers or any of its staff shall not be held liable for any claims of ownership over the said property, that I hereby undertake to answer such claims, demands, cause of action of whatever nature arising out such claims of ownership and/or approval of the application for a change of account name;

5. I further agree that this WAIVER, RELEASE AND QUITCLAIM may be pleaded as bar to any suit or proceeding to which either I, my legal heirs and assigns, may have against BENECO in connection with the approval of the application for change of account name;

6. As such, I finally make manifest that I have no claim(s) or cause of action neither against any employee nor against any person connected with the administration and operation of BENECO and forever release the latter from any and all liability;

7. I am executing this affidavit to attest to the truth of the foregoing facts without any intent to circumvent any existing laws and regulations and to comply with the requirements of BENECO and for the legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this __th day of ______, ______at ______, Philippines.

______Affiant ID No.______Issued on______Issued at ______

SUBSCRIBED AND SWORN to before me this ___th day of ______, in the ______. Affiant exhibited to his/her Identification Card as indicated below his/her name and signature.

Doc. No. ; Page No. ; Book No. ; Series of 20__.